- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.28 / $4,964.00 / $7,119.04
| Facility | | $1,586.28 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.06 / $790.41 / $1,709.43
| Professional | | $497.06 | $790.41 | $1,709.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.60 / $1,303.38 / $7,123.00
| Facility | | $767.60 | $1,303.38 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.21 / $1,322.47 / $2,961.89
| Facility | | $991.21 | $1,322.47 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |